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UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT <br />9a. ORGANIZATION'S NAME <br />Health Plex Fitness Center, Inc. <br />OR 9b. INDIVIDUAL'S LAST NAME I FIRST NAME I M <br />11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insertonl <br />111 a. ORGANIZATION'S NAME <br />2003110►55 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />debtor name (11 a or 11 b) -do not abbreviate or combine names <br />Harland Financial Solutions <br />FILING OFFICE COPY — NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) 400 S.W. 6th Avenue, Portland, Oregon 97204 <br />f' <br />3 <br />I <br />11 b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />Norton <br />Lisa <br />J <br />11 c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />3008 S Blaine <br />Grand Island <br />NE <br />68803 <br />USA <br />11 d. TAX 10 It. SSN OR EIN <br />ADD'L INFO RE 111 e. TYPE OF ORGANIZATION <br />11f. JURISDICTION OF ORGANIZATION 11 g. ORGANIZATIONAL ID #, if any <br />ORGANIZATION Individual <br />I <br />DEBTOR <br />NONE <br />12. <br />ADDITIONAL SECURED PARTY'S or ASSIGNOR S /P'S NAME - insert only one name (12a or 12b) <br />12a. ORGANIZATION'S NAME <br />OR <br />12b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />12c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />13. This FINANCING STATEMENT covers ❑ timber to be cut or ❑ as- extracted <br />16. Additional collateral description: <br />collateral, or is filed as a IN fixture filing. <br />14. Description of real estate: <br />Lots One (1), Two (2), and Three (3 ), Bonsall Subdivision in <br />the City of Grand Island, Hall County, Nebraska excepting <br />therefrom the south 50 feet of said Lot Three <br />15. Name and address of a RECORD OWNER of above - described real estate <br />(if Debtor does not have a record interest): <br />Brian Scott Norton <br />3008 S Blaine <br />17. Checkoff it applicable and check only one box <br />Grand Island, NE 68803 <br />Lisa J Norton <br />Debtor is a rl Trust or rl Trustee acting with respect to property held in trust or Decedent's <br />Estate <br />3008 S Blaine <br />18. Check only if applicable and check only one box. <br />Grand Island, NE 68803 <br />Debtor is a TRANSMITTING UTILITY <br />Filed in connection with a Manufactured -Home Transaction — effective 30 years <br />Filed in connection with a Public - Finance Transaction — effective for 30 years <br />Harland Financial Solutions <br />FILING OFFICE COPY — NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) 400 S.W. 6th Avenue, Portland, Oregon 97204 <br />f' <br />3 <br />I <br />